博碩士論文 102552026 詳細資訊




以作者查詢圖書館館藏 以作者查詢臺灣博碩士 以作者查詢全國書目 勘誤回報 、線上人數:16 、訪客IP:54.198.246.164
姓名 周柏良(Po-Liang Chou)  查詢紙本館藏   畢業系所 資訊工程學系在職專班
論文名稱 氣喘病患者罹患骨質疏鬆性骨折的風險 與相關風險因子: 以台灣全人口基礎的前瞻式世代研究
(Risk of Osteoporotic Fractures in Patients with Asthma: A Population-based Perspective Cohort Study in Taiwanese People)
相關論文
★ 應用嵌入式系統於呼吸肌肉群訓練儀之系統開發★ 勃起障礙與缺血性心臟病的雙向研究: 以台灣全人口基礎的世代研究
★ 使用穿戴式裝置分析心律變異及偵測心律不整之應用程式★ 建立一個自動化分析系統用來分析任何兩種疾病之間的關聯性透過世代研究設計以及使用承保抽樣歸人檔
★ 青光眼病患併發糖尿病,使用Metformin及Sulfonylurea治療得到中風之風險:以台灣人口為基礎的觀察性研究★ 利用組成識別和序列及空間特性構成之預測系統來針對蛋白質交互作用上的特殊區段點位進行分析及預測辨識
★ 新聞語意特徵擷取流程設計與股價變化關聯性分析★ 藥物與疾病關聯性自動化分析平台設計與實作
★ 建立財務報告自動分析系統進行股價預測★ 建立一個分析疾病與癌症關聯性的自動化系統
★ 基於慣性感測器虛擬鍵盤之設計與實作★ 一個醫療照護監測系統之實作
★ 應用手機開發手握球握力及相關資料之量測★ 利用關聯分析全面性的搜索癌症關聯疾病
★ 全面性尋找類風濕性關節炎之關聯疾病★ 利用機器學習法估算台灣無測站區域之PM2.5濃度
檔案 [Endnote RIS 格式]    [Bibtex 格式]    [相關文章]   [文章引用]   [完整記錄]   [館藏目錄]   [檢視]  [下載]
  1. 本電子論文使用權限為同意立即開放。
  2. 已達開放權限電子全文僅授權使用者為學術研究之目的,進行個人非營利性質之檢索、閱讀、列印。
  3. 請遵守中華民國著作權法之相關規定,切勿任意重製、散佈、改作、轉貼、播送,以免觸法。

摘要(中) 哮喘是一種常見的肺部疾病,其特點具有慢性發炎,氣流阻塞和支氣管過度反應性。有研究報告指出,慢性炎症可能導致細胞激素(免疫反應)的產生,進而刺激骨再吸收與形成導致增加骨折風險。然而,在氣喘中骨質疏鬆性骨折的發病機制目前還不清楚。目前,類固醇是治療哮喘的最有效的抗發炎藥物。當病患服用低劑量的吸入式類固醇控制不良時,則必須增加吸入式類固醇的劑量或者再加入長效支氣管擴張劑或全身性類固醇。因此,類固醇治療用於氣喘治療和骨質疏鬆性骨折之間扮演一個重要的關鍵因素。因此我們從全民健康保險研究資料庫抓取50歲以上的新發氣喘病患,再來排除一些會影響我們研究的病患,然後評估氣喘以及共病是否會影響得到骨質疏鬆性骨折的風險。最後,我們觀察到使用類固醇治療的氣喘病患,如使用吸入式類固醇加長效支氣管擴張劑的群組與使用全身性類固醇的群組,與那些沒有使用任何類固醇治療的病患有顯著增加骨質疏鬆性骨的風險。其風險分別為,吸入式類固醇加長效支氣管擴張劑 (HR=5.82, 95% CI=1.31-25.86, p-value=0.0205), 全身性類固醇 (HR=3.24, 95% CI=1.23-8.55, p-value=0.0174)。
摘要(英) Asthma is a common pulmonary disorder, which is characterized by chronic inflammation, airflow obstruction and bronchial hyperresponsiveness. Some study has reported that the chronic inflammation may leads to the production of cytokines, stimulating bone turnover and increased fracture risk. However, mechanisms of osteoporotic fracture in asthma disease is unclear. Currently, corticosteroids is the most effective anti-inflammatory drug for patients with asthma. When patients do not control asthma well with the low-dose ICS, they have to either increase the dosage of ICS or add the long-acting ß-agonist (LABA) or systemic corticosteroids controller medication .Thus, corticosteroids treatment is acts as an intermediary between asthma and the osteoporotic fracture, it is an important key factor. Therefore, we explore over 50 years old newly asthma patients from National Health Insurance Research Database (NHIRD), exclude some patients who affect our study and evaluate the effects of comorbidities with asthma on the osteoporotic fracture risk. Finally, we observe that patients with asthma who take the corticosteroids treatment such as ICS+LABA used group and SCS used group compared with who not use any corticosteroids, there is increase risk of osteoporotic fracture on asthma patients (HR=5.82, 95% CI=1.31-25.86, p-value=0.0205), (HR=3.24, 95% CI=1.23-8.55, p-value=0.0174) respectively.
關鍵字(中) ★ 台灣健保資料庫
★ 氣喘
★ 骨鬆性骨折
關鍵字(英) ★ HNIRD
★ Asthma
★ Osteoporotic Fractures
論文目次 中文摘要 i
ABSTRACT ii
Table of Contents iv
List of Figures vi
List of Tables vii
Chapter 1 Introduction 1
1.1 Background 1
1.2 Motivation 2
1.3 Research Goal 2
Chapter 2 Related Works 3
2.1 Asthma 3
2.2 Obstructive Airway Disease and Osteoporotic fracture 3
Chapter 3 Materials and Methods 5
3.1 Data Source 5
3.2 Study Design and Cohort Selection 5
3.3 Definition of Disease 7
Asthma 7
Osteoporotic Fractures 7
3.4 Confounding Factors 8
3.5 Statistical Analysis 9
Chapter 4 Results 10
4.1 Demographic Characteristics 10
4.2 Incidence Rate and Risk of Asthma between Two Cohorts 12
4.3 Relative Risk of Osteoporotic Fracture among Asthma Cohorts 13
4.4 Medication Treatment Effects 17
4.4.1 Study Cohorts Selection 17
4.4.2 Incidence Rate and Risk of Osteoporotic Fracture 18
4.5 Kaplan-Meier Osteoporotic Fracture -Free Curves 19
Chapter 5 Discussion 21
Chapter 6 Conclusion 24
References 25
參考文獻 1. Anne M. Fitzpatrick, W. Gerald Teague, Fernando Holguin, Mary Yeh, Lou Ann S. Brown. Airway glutathione homeostasis is altered in children with severe asthma: Evidence for oxidant stress. American Academy of Allergy, Asthma & Immunology. 2009. 0091-6749.
2. National Asthma Education and Prevention Program (National Heart Lung and Blood Institute). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma: Full Report 2007. U.S. Department of Health and Human Services.
3. Sanja Stanojevic, Ginette Moores, Andrea S Gershon, Eric D Bateman, Alvaro A Cruz and Louis-Philippe Boulet. Global asthma prevalence in adults: findings from the cross-sectional world health survey. BMC Public Health 2012, 12:204.
4. Yi-Chun Ma, Cheng-Chieh Lin, Chia-Ing Li, Jen-Huai Chiang, Tsai-Chung Li,Jaung-Geng Lin. Time-trend analysis of prevalence, incidence and traditional Chinese medicine use among children with asthma: a population-based stud. Public Health 2015, pp. 1–9.
5. I-Shiow Jan, Wei-Hui Chou, Jung-Der Wang, and Sow-Hsong Kuo1. Prevalence of and Major Risk Factors for Adult Bronchial Asthma in Taipei City. J Formos Med Assoc 2004;103:259-63.
6. James W. Mims, MD. Asthma: Definition and Pathophysiology. International Forum of Allergy & Rhinology, Vol. 5 No.S1 2015.
7. John Rees. Definition and Diagnosis. British Medical Volume 288 1984.
8. K.J. Abernathy-Carver, L.L. Fan, M. Boguniewicz, G.L. Larsen, and D.Y.M. Leung. Legionella and Pneumocystis Pneumonias in Asthmatic Children on High Doses of Systemic Steroids. Pediatric pulmonology 18:135-138 1994.
9. Mohammed Mahmoud Ahmed, Nabil Farouk, Ihab Weheba, Abeer Shehata, Maha Abdel Hadi, Nabila La. Asthmatic Patients and the Risk of Osteoporosis. Applied Sciences Research, 8(5): 2832-2838, 2012.
10. Alberto Papi, Brunilda Marku et al. Regular versus as-needed budesonide and formoterol combination treatment for moderate asthma: a non-inferiority, randomised, double-blind clinical trial. Lancet Respir Med 2014.
11. Stefan Hummel, Lasse Lehtonen et al. Comparison of oral-steroid sparing by high-dose and low-dose inhaled steroid in maintenance treatment of severe asthma. The Lancet 1992 No 8834/8835.
12. Lawrence M. Dolan, Hemant H. Kesarwala, Jane C. Holroyde, Thomas J. Fischer. Short-term, high-dose, systemic steroids in children with asthma: The effect on the hypothalamic-pituitary-adrenal axis. J Allergy Clin Immunol 1987;80:81-7.
13. John A.Kanis, L. Joseph Melton, Claus Christiansen, Conrad C. Johnston, Nikolai Khaltaev. The Diagnosis of Osteoporosis. Journal of Bone and Mineral Research Volume 9, Number 8, 1994.
14. Steven R.Cummings, Jennnifer L. Kelsey, Michael C. Nevitt, and Kenneth J. O’dowd. Epidemiology of Osteoporosis and Osteoporotic Fractures. Johns Hopkins University School of Hygiene and Public Health Vol. 7,1985.
15. Steven R Cummings, L Joseph Melton III. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002; 359: 1761-67.
16. O. Johnell & J. A. Kanis. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006 17:1726-1733.
17. Allen D. Adinoff, J. Roger Hollister. Steroid-Induced Fractures and Bone Loss in Patients with Asthma. The New England Journal of Medicine 2010 Vol.309 No.5.
18. Pen Li, Laith Ghazala, Erin Wright, Jeremy Beach, Donald Morrish, Dilini Vethanayagam. Prevalence of Osteopenia and Osteoporosis in Patients with Moderate to Severe Asthma in Western Canada. Clin Invest Med 2015; 38 (2): E23-E30.
19. John A Kanis, Helena Johansson, Anders Oden, Olof Johnell, Chris de Laet, L Joseph Melton III, Alan Tenenhouse, Jonathan Reeve, Alan J Silman, Huibert AP Pols, John A Eisman, Eugene V McCloskey, and Dan Mellstrom. Meta-Analysis of Prior Corticosteroid Use and Fracture Risk. Journal of Bone and Mineral Research Volume 19, Number 6, 2004.
20. Karine Briot, Christian Roux. Glucocorticoid-Induced Osteoporosis. RMD Open 2015;1:e000014.
21. O. Johnell A J.A. Kanis A A. Ode’n A I. Sernbo I. Redlund-Johnell A C. Petterson A C. De Laet B. Jonsson. Mortality after osteoporotic fractures. Osteoporos Int (2004) 15: 38–42.
22. Aleksandra Wardzyn´ ska, Beata Kubsik and Marek Leszek Kowalski. Comorbidities in elderly patients with asthma: Association with control of the disease and concomitant treatment. Geriatr Gerontol Int 2015; 15: 902–909.
23. Brian J Smith, Patrick J Phillips and Richard F Heller. Asthma and chronic obstructive airway diseases are associated with osteoporosis and fractures: A literature review. Respirology (1999) 4, 101–109.
24. S. A. Aljubran, G. J. Whelan, M. C. Glaum & R. F. Lockey. Osteoporosis in the at-risk asthmatic. Allergy 69 (2014) 1429–1439.
25. Jae-Woo Jung, Hye-Ryun Kang, Ju-Young Kim, So-Hee Lee, Sun Sin Kim, Sang Heon Cho. Are Asthmatic Patients Prone to Bone Loss? Ann Allergy Asthma Immunol 112 (2014) 426-431.
26. Robert A. Goldstein. Asthma. Ann Intern Med. 1994;121:698-708.
27. R. G. Stirling, K. F. Chung. Severe Asthma: Definition and Mechanisms. Allergy 2001: 56: 825–840.
28. Don D. Sin, Jonathan P. Man, Paul Man. The Risk of Osteoporosis in Caucasian Men and Women with Obstructive Airways Disease. J Med. 2003;114:10 –14.
29. F. de Vries, T.P. van Staa, Bracke, C. Cooper, Leufkens and J-W.J. Lammers. Severity of Obstructive Airway Disease and Risk of Osteoporotic Fracture. Eur Respir J 2005; 25: 879–884.
30. T.-T. Dam, S. Harrison, H. A. Fink, J. Ramsdell, E. Barrett-Connor. Bone Mineral Density and Fractures in Older Men with Chronic Obstructive Pulmonary Disease or Asthma. Osteoporos Int (2010) 21:1341–1349.
31. National ealth Insurance Annual Report 2015-2016.
32. Jennifer W. McCallister, Janet T. Holbrook, Christine Y. Wei, Jonathan P. Parsons, Cathy G. Benninger, Anne E. Dixon, Lynn B. Gerald, John G. Mastronarde. Sex Differences in Asthma Symptom Profiles and Control in The American Lung Association Asthma Clinical Research Centers. Respiratory Medicine (2013) 107, 1491e1500.
33. JGC Verheij, WGM Geraets, PF van der Stelt, K Horner, C Lindh, K Nicopoulou-Karayianni, R Jacobs, EJ Marjanovic, JE Adams and H Devlin. Prediction of Osteoporosis with Dental Radiographs and Age. Dentomaxillofacial Radiology (2009) 38, 431–437.
34. Minyan Liu, Ying Zhang, Xiaoling Cheng, Yanhui Lu, Nan Li, Yanping Gong, Yu Pei, and Chunlin Li. The Effect of Age on the Changes in Bone Mineral Density and Osteoporosis Detection Rates in Han Chinese Men Over the Age of 50. Aging Male, 2014; 17(3): 166–173.
35. L. Joseph Melton, III A Ashok Patel A Sara J. chenbach Ann L. Oberg A John W. Yunginger. Long-term Fracture Risk Following Adult-Onset Asthma: a Population-Based Study. Osteoporos Int (2004) 15: 311–316.
36. Dirkje S. Postma. Gender Differences in Asthma Development and Progression. GENDER MEDICINE/VoL. 4, SUPPL. B, 2007.
37. J. Kanis, O. Johnell, B. Gullberg, E. Allander, L. Elffors, J. Ranstam, J. Dequeker, G. Dilsen, C. Gennari, A. Lopes Vaz, G. Lyritis, G. Mazzuoli, L. Miravet, M. Passeri, R. Perez Cano, A. Rapado and C. Ribot. Risk Factors for Hip Fracture in Men from Southern Europe: The MEDOS Study. Osteoporos Int (1999) 9:45–54.
38. Conroy A Wong, Lesley J Walsh, Christopher J P Smith, Antoni F Wisniewski, Sarah A Lewis, Richard Hubbard, Sue Cawte, Desmond J Green, Michael Pringle, Anne E Tattersfield. Inhaled Corticosteroid Use and None-Mineral Density in Patients with Asthma. Lancet 2000; 355: 1399–403.
39. Khosla, LJ Melton III and BL Riggs. Osteoporosis: gender differences and similarities. Lupus (1999) 8, 393±396.
40. Lidwien Graat-Verboom, Frank W.J.M. Smeenk, Ben E.E.M. van den Borne, Martijn A. Spruit, Frits H. Jansen, Joris W.T. van Enschot, Emiel F.M. Wouters. Progression of Osteoporosis in Patients with COPD: A 3-Year Follow Up Study. Respiratory Medicine (2012) 106, 861e870.
41. Diane M. Biskobing. COPD and Osteoporosis. CHEST 2002; 121:609–620.
42. P. Rtiegsegger, T. C. Medici, and M. Anliker. Corticosteroid-Induced Bone Loss. A Longitudinal Study of Alternate Day Therapy in Patients with Bronchial Asthma Using Quantitative Computed Tomography. Eur J Clin Pharmacology (1983) 25:615-620.
指導教授 洪炯宗(Jorng-Tzong Horng) 審核日期 2016-7-22
推文 facebook   plurk   twitter   funp   google   live   udn   HD   myshare   reddit   netvibes   friend   youpush   delicious   baidu   
網路書籤 Google bookmarks   del.icio.us   hemidemi   myshare   

若有論文相關問題,請聯絡國立中央大學圖書館推廣服務組 TEL:(03)422-7151轉57407,或E-mail聯絡  - 隱私權政策聲明